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Hospitals in at least 25 states are critically short of nurses, doctors, and other staff as coronavirus cases surge across the United States, according to the industry’s trade association and a tally conducted by STAT. The situation has gotten so bad that in some places, severely ill patients have been transferred hundreds of miles for an available bed — from Texas to Arizona, and from central Missouri to Iowa.

Many of these hospitals spent months building up stockpiles of medical equipment and protective gear in response to Covid-19, but the supplies are of little use without adequate staffing.

“Care is about more than a room with a hospital bed. It’s about medical professionals taking care of patients,” said John Henderson, chief executive of the Texas Organization of Rural & Community Hospitals (TORCH). “If you don’t have the staff to do that, people are going to die.”

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Staffing shortages are a serious concern in multiple regions. Intensive care unit nurses, who typically oversee no more than two patients at a time, are now being pushed to care for six to eight patients to make up for the shortfall in parts of Texas, said Robert Hancock, president of the Texas College of Emergency Physicians. In Ohio, some 20% of the 240 hospitals tied to the Ohio Hospital Association are reporting staffing shortages, according to spokesperson John Palmer.

The American Hospital Association’s vice president of quality and patient safety, Nancy Foster, said she’s heard from two dozen hospital leaders over the past two weeks, warning her of staffing shortages in states including Texas, North and South Dakota, Minnesota, Wisconsin, and Illinois. Health care providers in Kansas, Oklahoma, Arkansas, Ohio, Missouri, Michigan, and Utah said they’re facing the same problem, as do local reports from New Mexico, Nebraska, Colorado, Wyoming, Tennessee, Georgia, Alabama, Indiana, Montana, California, Rhode Island, and South Carolina.

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The shortages are primarily caused by overwhelming numbers of patients as coronavirus spreads, combined with decreasing staff levels as nurses and doctors themselves fall sick or have to quarantine after being exposed to infected people. Covid-19 is also prevalent in rural areas that have been struggling with a shortage of health professionals for years; hospitals in more remote regions don’t have equipment such as ventilators, and so must transfer severely ill patients to already-overwhelmed urban health care systems. The scale of the problem makes it harder to address: Systems designed to offset shortages by bringing in backup from other areas don’t work when so many states are affected simultaneously.

States that sent doctors and nurses to New York at the beginning of the pandemic now have no one to turn to as hospitals across the country experience the same problem. “Early on, Texas was sending teams of caregivers to states like New York to help with their surge,” said Henderson. “You can’t do that when 48 states are going through a surge in the wrong direction and they all need help. Where do you pull from?”

As the crisis proliferates, several health care systems are struggling to transfer urgent patients to hospitals with adequate support. Hospitals in Lubbock, Texas, had to send severe Covid-19 patients to Arizona, said Henderson. A Missouri patient who urgently needed surgery to remove a mass in his brain was sent to a hospital in Iowa, said Alex Garza, head of the St. Louis regional pandemic task force and community health officer at SSM Health in St. Louis.

“The mechanics of how you transport and accelerate care are broken at the moment,” said Henderson. Even major cities in Texas, such as Houston, Dallas, and Austin, are facing their own staff limitations, and so many rural hospitals in Texas are forced to try and treat patients that they would typically transfer out.

Covid-19 has so overwhelmed parts of Texas, including El Paso and Lubbock, that hospitals are running short of both beds and staff. “I treated a clinical patient in a recliner, because it was the only thing close to a bed we could find,” said Hancock, who works at hospitals in Oklahoma, Dallas-Fort Worth, and Amarillo, Texas, but declined to say where the incident happened. “We knew the patient was sick and had nowhere to put them. You look at what resources you’ve got and make it happen.”

The lack of staff reflects the dramatic increase in patients. There has been an average of 157,318 new cases per day over the past week, according to the STAT Covid-19 Tracker — 74% more than two weeks ago — and there simply aren’t enough ICU nurses, in particular, to meet the need. Hospitals currently have 2,000 ICU nurse jobs open on Trusted Health, a company that connects travel nurses, who hop from job to job around the country, with hospitals.

The situation is exacerbated as staff get sick with coronavirus themselves, or else have to quarantine after exposure. The staffing need is so dire, hospital workers who have tested positive for Covid-19 but are asymptomatic have been told to continue working in North Dakota.

One rural hospital in Texas is struggling with 30% of staff nurses out of commission because of infection with or exposure to Covid-19, said TORCH’s Henderson. At one point earlier this month, more than 1,000 staff from the Mayo Clinic were out of work because of Covid-19, said Amy Williams, executive dean of Mayo Clinic Practice.

“It could be caring for a family member who has Covid, it could be on quarantine because of being exposed in the community, or it could be because the staff member actually has Covid,” Williams said. More than 90% of possible exposures occurred in the community as transmission picked up, she said, not in the hospital.

As health care systems compete for additional staff, salaries skyrocket. ICU nurses are a “hot commodity,” said Dan Weberg, a former emergency room nurse and head of clinical innovation at Trusted Health, and their fees are currently twice as much as pre-Covid rates, at around $5,000 to $6,000 per week.

“This is how PPE was in the beginning of the pandemic. When you’re competing with everyone else in town, and state, and the country, that creates a market that’s not sustainable,” said SSM Health’s Garza.

In response to the staffing shortage, several hospitals are postponing elective surgeries as many did in the spring at the start of the pandemic. This decision carries risks: “They call them elective but a lot are what I’d call urgent cases,” said Hancock, the Texas emergency physician. A surgeon recently had to cancel two intestinal surgeries for patients who were struggling to eat, said Kencee Graves, associate chief medical officer at University of Utah Health. Patients waiting for knee surgeries may well struggle to walk.

But there are few alternatives for health care systems. “You can always add more beds. It’s much more difficult to add more workforce,” said Alan Morgan, chief executive of the National Rural Health Association. Some hospitals are turning to local dentists and Red Cross volunteers, and people with basic health experience to help with tasks that require less training, said the American Hospital Association’s Foster.

The only other option is to ask existing staff to work more hours. University of Utah Health has been using additional ICU beds for months, which means nurses and providers are working extra shifts. “Our numbers keep increasing but they are tired. Our nurses feel like there’s no end in sight,” said Graves. “They get here, work 12 hour shifts in PPE, it’s just this churn of seeing critically ill patients. And then you go to your community and see peak numbers, and having people continue to go to bars and restaurants.”

Trusted Health is trying to set a maximum of 60 hours per week in its nursing contracts. After working more than three 12-hour shifts in a row, error rates go up “exponentially,” said Weberg.

What most worries hospital officials is that Covid-19 has not yet reached its peak. “What I’m scared of, leading up to the holidays, is what’s going to happen immediately after Thanksgiving,” said Hancock. “Then everyone gets into a crisis situation and there’s nobody who can go help.”

Their only hope is for demand to decrease by people reducing Covid-19 transmission through quarantining and wearing masks, they said. “Many of us feel powerless because we feel people aren’t listening when we say don’t gather for Thanksgiving or Christmas,” said Graves. After months of dealing with the crisis, she worries that some nurses will be so burned out they’ll quit, making the staffing shortage even worse.

Both hospitalizations and deaths are lagging indicators, meaning it takes a couple of weeks for newly diagnosed cases to translate into more ICU patients. “We’re in for a very rough Thanksgiving and Christmas,” said Henderson.

  • This is what happens when your so called government puts their hand in it. This could of been gotten a hold of if your government wouldn’t of just turned a blind eye, to them your expendable. The system is broken, and your government knows this. Reach out and thank those good ole boys for caring about you and every person in our land of the free. Right.

    • The people who continue to eat the at restaurant, drink at bars, and do parties, refuse to wear a mask are mostly to blame. Contract tracing in different states shows that gatherings and indoor dining are the main cause of this current spread.

      Some people just made one single mistake of hosting a party or dining indoor in a restaurant and end up dying from covid19. One cannot relax one’s vigilance until this covid19 is over.

      There is a reason why Asian countries can control it and the other countries cannot, and that is being vigilant in protecting oneself.

    • Agree!! The only way you might get into the hospital as an LPN is through agency staffing. I was turned down many times and could do vents, trach care, IV therapy, start peripheral lines of IV therapy, peritoneal dialysis, wound care, wound Vac therapy…..and of course pass meds…. I never understood why it was difficult to get on at the hospitals? I ended up working LTC for 20 years with 30 to 40 patients and all kinds of care plans…. the money was good but you worked very hard all shift many times without breaks and lunch. I couldn’t afford to go back to school but loved to learn from others and was comfortable in any setting. Maybe if they get short we will get a chance to get back into hospitals. RN’s love the help and don’t mind working with LPN’s .

    • I have been watching what’s happening in my community regarding covid. I have the unique perspective of being a healthcare worker but I only work one day a week. I also am friends with a pediatrician. So right now I know at least 6 different families that actively have covid. They are all sick but none of them are in the hospital or dieing. Some of them are older( in their 60’s) and have underlying health conditions. In my area there has been a significant uptick in covid infection. Where I work the staff is getting sick and having to go home, leaving holes in the staffing on the nursing floors. It’s not at emergency levels yet but it could get there pretty quick as I see more staff off on quarantine every week. A pediatrician I am friends with told me that the rapid tests they do in the office have been noted to bring back false positives 40% of the time. They know this because when they do a rapid test they also send in another test to the lab that is the better more sensitive test. Kind of like when you get a strep test.
      So my take is the positivity rate is being presented higher than it actually is because of false positives. People are getting really sick but not as many are dieing as it appears to be. Yes we do have a problem with the available healthcare workers because now they are becoming sick and unable to work. This is what I know from looking at the situation in my area of Illinois and no I don’t live in Chicago or around it.

  • Pay off some student loans for nurses to come and work these critical shortage areas and I bet you will have more nurses coming to assist than you know what to do with.

    • Yes, I agree. I’m a LVN in Texas, 20 minutes from Houston and would love to go back for my RN, but can’t due to loans. Would love to help out, but loans are maxed. I’m sure this is the problem with a lot of LVN’s.

    • Pay your own loan. But rather these nurses should be given higher salary for taking risk if they work with covid19 patients. They should also be provided proper PPE and educate them how to use the PPE properly.

      They probably should install some device to filter the air as much as possible of covid19.

      As healthcare workers takes care of covid19 patients, the institution they works for should insure their safety.

  • If the material and anecdotes presented in the above article are true, I for one am astounded and disappointed at the American Association of Medical Colleges for not doing more to open up more seats to students at their medicals schools beginning this admissions cycle. As an applicant myself, I have been told by admissions committees that there are at least 100 students per every seat available in the class. I am sure the rates are comparable for nursing, assistants, even community health workers as states expand coverage. Tens of thousands of EXTREMELY TALENTED students are rising to the call of duty amongst the healthcare professions seeking to contribute their skills to this pandemic. Both the American Hospital Association and American Medical Associations need to come together with others to determine whether the bottleneck of exclusivity is really necessary. Given today’s virtual reality, see what you can do to increase access to health professions education to all those who desire to learn. Those of you medical leaders interested in “healthcare for all”: it won’t happen without medical education access for all to meet the demand that “healthcare for all” requires. To the institutions of America that govern medical education: when your priorities become people instead of profit, when your business models and KPIs reflect value of wellbeing over value for money, you will see that only YOU have the power to change it. Thanks to the pandemic, the type is ripe for entrepreneurial and innovative thinking. GET ON IT. Best, a medical school applicant

    • I hope your “Healthcare for all’ dig is not suggestive that you support a system of Healthcare for SOME and to hell with everybody else. If so, YOU are not needed in healthcare.

    • Sorry there are 6-7K US citizen med school grads every year (all sources) that dont get jobs. There is no shortage of med school slots. There is a MASSIVE shortage of residency slots. I went to school later and life and decided I didnt want to practice. I didnt enter the Match because I didnt want to contribute to that problem even though my post school career would have benefitted tangentially from doing a residency.

  • The plandemic propaganda continues without letup. Biggest hoax perpetuated against unsuspecting people ever. CDC and Fauci and Friends who have locked up patents on these Corona viruses stand to cash in big time. Guess what, the mortality curve of Covid is identical to the natural mortality curve in other words people are dying from underlying conditions as would d and they are blaming the deaths on this phantom killer virus, that 85% of people who test positive only know they have because they are tested. So let all the quacks chime in here and call me ignorant. I’ll compare my IQ to yours any day of the week.

    • REALLY folks? Hmm. One of our local hospitals in a metro area of 200,000 and while cases are running high, we are not considered a “hot spot” yet, has all ICU beds filled. Oh, they have 26 more beds they created, but they do not have the staff to use them. Their Covid ward of roughly 25 beds is full and they added another 25 beds on another floor. A different hospital just added 50 beds to their Covid ward. Beds are nice, but what do you think happens when hospital staff starts to become infected as well. YOU LOSE YOUR STAFFING CAPABILITIES.

      I am glad you think things are rosy where you are. But do not even TRY to speak for the rest of the country. And Jay, this is not about IQ numbers. It is about common sense. I have known some brilliant people over the years who were woefully ignorant of the real world and how it operates. And yes folks, I am a volunteer in the emergency management sector so I do know of what I speak locally, in my State, and even regionally in the tri State area.

      So again..Do not try to speak for the rest of the country.

    • The person who thinks he’s the smartest person in the room always seems to be dumbest. You must be an absolute idiot!

  • I can not believe you are trying to say there’s a shortage they just laid off ICU nurses at my hospital . Apparently we are overstaffed. I’ve spoken with them since they have tried getting jobs at some of these so-called hot areas they are not hiring. I suppose I should not be too shocked after all the local media stated our hospital was slammed with covid-19 in reality we had two at the time. Every one I know that works at the three other hospitals in the area had 0 at the time.

    • Lots of anedoctal misinformation out there. Most of Michigan is not slammed. I know, I see our local data every day. Some hospitals have it worse than others but it is nowhere near April at this point. Lots of cases but hospitalization is way down as a percentage of cases and total ICU beds are down as well. Doesnt mean some aren’t crushed but its not as bad as the media points out. Alot of people looking for excuses, sympathy, or money…

    • I don’t see any action taking to increase residency position. It’s unique problem in the USA that Medical graduates are struggling to get a training after fully qualified by their approved method. It’s dis respect to their won methodology and brain drain of highly educated personals. No fund for residency training but crying for doctor shortage. I don’t think USA can’t make a fund for training more doctors, if no fund please open the door for free residency training, thousands of qualified candidate will work for you.

  • Lying to us still. Not enough deaths to be a pandemic. Positive test are unreliable and mostly false positives. Can you stop the fear mongering when you don’t blame Democrats for loading up nursing homes with Covid patients. Maybe the one group this virus kills.

    • Please report the real statistics. This article is fear mongrel. As a nurse I deployed out of state at the beginning of the pandemic and the reality is NOT what the media is reporting!

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